24-Hour Health Coverage and Workers Comp

March 31, 2017 | Workers Compensation

Traditionally, health insurance and workers’ compensation insurance have been independently managed, even when an employer is paying for both. Under 24-hour coverage, however, these two programs are merged for convenience and money-saving benefits.

What Is 24-Hour Coverage?

24-hour coverage is a unique, hybrid concept that only a few states in the nation have experimented with. Under a 24-hour coverage plan, an employee’s health benefits and workers’ compensation benefits are rolled into one, and all of the employee’s health needs – whether occupational or non-occupational – are covered by the employer. Another way to phrase is that The term 24-hour coverage is a combination of general health coverage and workers’ compensation coverage.

The 24-hour coverage pilot offers advantages for employers and employees. By contracting with an exclusive provider of health care, savings are achieved by reducing administrative duplication. Participating employers insured by a workers’ compensation carrier are eligible for reduction in their workers’ compensation premiums. In addition, employer control over an injured worker’s medical treatment is extended to up to one year from the current 30 days.

Employees choosing to enroll will benefit from the convenience and continuity of care from the same doctor/health care provider giving all of their health care needs.

Employers participating in the 24-hour coverage pilot are expected to experience a reduction in their health care costs. The exact amount, however, cannot be determined by estimation. Indeed, an goal of the pilot project is to quantify savings and potential benefits of this type of medical coverage.

What Are the Benefits of 24-Hour Coverage?

The benefits of 24-hour coverage are clear; not only do employee enjoy greater healthcare security, as they are guaranteed medical care for all of their illnesses and injuries and can see one doctor for all of their needs, but employers save money, too. Savings are gained as a result of reduced administration costs, and participating employers typically (depending upon location) receive a reduction in premiums for selecting 24-hour coverage. It is also estimated that by opting for 24-hour healthcare coverage, employers may also save money in workers’ compensation litigation costs, which are common when there is a dispute over whether or not an injury is truly work-related. By providing coverage regardless of how the accident happened, disputes are eliminated.

Where is 24-Coverage Offered?

There are only a handful of states that have laws permitting healthcare companies to provide coverage for both occupational and non-occupational illnesses, or pilot projects to explore 24-hour coverage. California has been considered a leader in the industry. Employees are expected to do their own research as to whether or not this type of coverage will be beneficial or cost-effective for their use. Once researched, the employer must also offer this type of coverage through their insurance provider which is not always reasonable or feasible, so that is also something to consider. As you can see, obtaining this coverage has the potential to be a lengthy and confusing process to undertake, and it would be best to have somebody close at hand who understands the laws and can navigate any red tape that may arise.

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